Provider Demographics
NPI:1306106919
Name:FAMILY AND CHILD DEVELOPMENT
Entity type:Organization
Organization Name:FAMILY AND CHILD DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST/ OWNE
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:850-862-3772
Mailing Address - Street 1:348 MIRACLE STRIP PKWY SW
Mailing Address - Street 2:STE 3 B
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5200
Mailing Address - Country:US
Mailing Address - Phone:850-862-3772
Mailing Address - Fax:850-863-4574
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW
Practice Address - Street 2:STE 3 B
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5200
Practice Address - Country:US
Practice Address - Phone:850-862-3772
Practice Address - Fax:850-863-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty